Healthcare Provider Details

I. General information

NPI: 1033443585
Provider Name (Legal Business Name): TAMMY VONA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 CHARLES ST
ELMIRA NY
14904-2709
US

IV. Provider business mailing address

1118 CHARLES ST
ELMIRA NY
14904-2709
US

V. Phone/Fax

Practice location:
  • Phone: 607-734-7107
  • Fax: 607-734-9708
Mailing address:
  • Phone: 607-734-7107
  • Fax: 607-734-9708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number016932
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: